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Privately Insured Patients’ Perceptions of Medical Severity and Who They First Contact for Help or Advice Strongly Associated with Decision to Seek Emergency Care

WASHINGTON
, DCContrary to the idea that convenience prompts many privately insured people to seek care in emergency departments (EDs), the people most likely to use EDs believe they urgently need medical attention, according to a new study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Many privately insured people with an urgent medical problem go to hospital emergency departments even though they could be treated safely and at a lower cost elsewhere. Understanding why privately insured patients decide to seek care in EDs rather than other settings can help purchasers and payers safely guide patients to less-costly care.

Patients’ perception of the severity of their medical problem and who they first contact for help or advice are the factors most associated with whether they seek emergency care, according to the HSC study based on NIHCR’s 2012 Autoworker Health Care Survey, which had a 64.2 percent response rate. The survey of 8,836 active and retired nonelderly autoworkers and spouseswhile not nationally representativeprovides a unique opportunity to examine why privately insured people decide to go to emergency departments when faced with an urgent medical problem.

Nearly a quarter of respondents (23%) reported having an urgent medical problem in the three months before the survey, and almost half (44%) of those with an urgent condition ultimately went to an emergency department for treatment. Of people with an urgent problem, nearly half first contacted their regular source of caretypically a primary care clinicianand those patients were less likely to go to emergency departments, the study found.

“When privately insured people have an urgent medical problem and cannot access their usual physician as quickly as they believe necessary, they frequently will go to hospital emergency departments,” said HSC Senior Researcher Emily Carrier, M.D., coauthor of the study with HSC Research Analyst Ellyn R. Boukus, M.A. “The findings indicate timely access to primary care clinicians and lower-cost settings that can provide a moderate intensity of care and urgent response time likely could reduce emergency department use.”

Only rarely did respondents cite convenience as a reason for choosing ED care. Moreover, people who reported that their primary doctor offered rapid access to advice and visits were significantly less likely to use emergency departments and instead relied on their primary clinician for urgent medical needs. However, despite their relatively comprehensive health coverage, the majority of respondents indicated they lacked this level of primary care access.

The study’s findings are detailed in a new HSC Research BriefPrivately Insured People’s Use of Emergency Departments: Perception of Urgency is Reality for Patientsavailable online at www.hschange.org/CONTENT/1399/. Key findings include:

Nearly half of respondents (49%) reported going to an emergency department in part because they believed their medical problem was an emergency and required immediate attention. And 30 percent indicated this was their sole reason, by far the most common response.

• Relatively few people cited convenience as a factor in deciding to go to an emergency department. About 7 percent indicated using an ED was driven partially by convenience, but less than 2.5 percent cited convenience as the sole reason for choosing an ED.

• About one in four people (24.8%) reported their doctor’s office was closed when they needed help, and close to a quarter (24.1 %) indicated their physician instructed them to go to an emergency department.
• When first deciding to seek medical care for an urgent problemeither a new problem or aggravation of an existing problemnearly half of all patients first contacted their physician for help or advice Another 20 percent called 911 or went straight to the ED, and 17 percent first contacted or visited an urgent care center.

People with coverage through a health maintenance organization (HMO) were more likely to contact their doctor when seeking urgent care (52% v. 43%) and were less likely to call 911 or go straight to the ED (17% vs. 22%).

Overall, those who first contacted their doctor were much less likely to go to an emergency department than other people. Among the 75 percent of patients with an urgent need who contacted a doctor’s office or clinic, nearly 60 percent were treated by a doctor or nurse in an office setting and another 12 percent were able to have their issue managed over the phone.

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The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nation's
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research.